Food Resource Center Intake Form
The IVC Food Resource Center is a free resource that provides registered IVC students some food support. To request a food bag from the Food Resource Center at Irvine Valley College, please follow these steps:
  1. Complete the Intake Form: The information provided will be used by the Basic Needs Program for reporting & funding purposes.
  2. Schedule an Appointment: https://esars.ivc.edu/frc/
  3. Provide Additional Information: If necessary, provide details about any crisis situations that led you to need food assistance. A staff member will follow up with you to schedule an appointment and help you connect with additional resources.
  4. Pick Up Your Food Bag: Visit the Food Resource Center (B105) during your scheduled appointment and bring your own bag.
If you find that you are relying on the center for all your food needs, or need additional support for other Basic Needs necessities, complete this form and a staff member will contact you to schedule an appointment. They will help connect you to campus and community resources.

If this matter is urgent please email Juanita Vasquez, Basic Needs Program Coordinator at jvasquez73@ivc.edu
Sign in to Google to save your progress. Learn more
Are you entering this form for someone else? If so, please enter your name, email address,  and how you know the student (friend, professor, ect)
First Name *
Last Name *
Student ID Number *
Student Email *
Phone Number *
Household Information
We care about your well-being and are here to help you get the support you need. Your information will be kept private and only shared with our Basic Needs Program team. They specialize in providing personal support through private appointments, connecting students to campus and community resources, and checking in to make sure you're getting the help you need.

Your privacy is important to us. We won't share your information with anyone outside our team without your permission. Let's work together to make sure you receive the support that's right for you.
What is your current housing situation? *
Homelessness means not having a “fixed, regular, and adequate” nighttime living arrangement. This includes couch-surfing, staying with other people because of loss of housing or economic hardship; staying in motels, hotels, or campgrounds; sleeping in a car, public place, or abandoned building; staying in a shelter or transitional housing; and other arrangements.
Required
In the last 3 months, which of following have you experienced at least once? (Check all that apply)
 *
Required
How many children (0-18 years old) are in your household?
 *
Please include yourself when answering this question. 
How many adults (19-60 years old) are in your household? 
 *
Please include yourself when answering this question. 
How many seniors (60+ years old) in your household?
 *
Please include yourself when answering this question. 
Are you a parent or legal guardian of a dependent (child under the age of 18)? *
Please read and acknowledge the FRC's Community Standards: https://www.ivc.edu/frc/policies
 *
Students Who Violate These Policies May Be Informed That They Can No Longer Utilize The Resources Provided By The FRC.
Would you like us to contact you to schedule an appointment for further assistance? *
Anything else you'd like us to know? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of South Orange County Community College District. Report Abuse
Google Forms